J O U RN A L OF GE RI A T RI C O NC O L O G Y 5 ( 2 01 4 ) 4 3 9 –44 6
Available online at www.sciencedirect.com
ScienceDirect
Potentially inappropriate medication use in older people with cancer: Prevalence and correlates Laura K. Saarelainena,b,1 , Justin P. Turnera,c,⁎,1,2 , Sepehr Shakibd , Nimit Singhale,f , Jonathon Hogan-Dorane , Robert Prowseg , Sally Johnsd , Judith Leese , J. Simon Bella,b,c a
Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Parkville, Victoria, Australia School of Pharmacy, Faculty of Health Sciences, University of Eastern Finland, Kuopio, Finland c School of Pharmacy and Medical Sciences, University of South Australia, Adelaide, South Australia, Australia d Department of Clinical Pharmacology, Royal Adelaide Hospital, Adelaide, South Australia, Australia e Department of Medical Oncology, Royal Adelaide Hospital, Adelaide, South Australia, Australia f School of Medicine, Adelaide University, Adelaide, South Australia, Australia g Geriatric and Rehabilitation Medication, Royal Adelaide Hospital, Adelaide, South Australia, Australia b
AR TIC LE I N FO
ABS TR ACT
Article history:
Objectives: Potentially inappropriate medication (PIM) use has been associated with an
Received 9 January 2014
increase in adverse drug events, hospitalization and mortality. This study investigated the
Received in revised form 2 May 2014
prevalence and factors associated with PIM use in patients presenting to a medical oncology
Accepted 24 July 2014
outpatient clinic.
Available online 7 August 2014
Materials and Methods: Consecutive patients (n = 385) aged ≥ 70 years referred to a medical oncology outpatient clinic between January 2009 and July 2010 completed a structured data
Keywords:
collection instrument. The instrument assessed medication use, diagnoses, self-reported
Aged
falls in the previous six months, pain (10-point visual analog scale [VAS]) and distress
Aged 80 and over
(10-point VAS). Frailty was defined using exhaustion, weight loss, Karnofsky Performance
Frail elderly
Scale, instrumental activities of daily living and physical function. PIM use was defined by
Inappropriate prescribing
the Beers Criteria. Logistic regression was used to compute odds ratios (ORs) and 95%
Medical oncology
confidence intervals (CIs) for factors associated with PIM use.
Medication therapy management
Results: In total, 26.5% (n = 102) of the sample used ≥1 PIM. The five most prevalent classes of PIMs were benzodiazepines (n = 34, 8.8%), tricyclic antidepressants (n = 16, 4.2%), alpha-adrenoreceptor antagonists (prazosin) (n = 15, 3.9%), propulsives (metoclopramide) (n = 15, 3.9%) and non-steroidal anti-inflammatory drugs (n = 14, 3.6%). In multivariate analyses, PIM use was associated with age 75–79 years (OR 1.83; 95%CI 1.02–3.26) compared to age 70–74 years, using ≥ 5 medications (OR 4.10; 95%CI 2.26–7.44) compared to
Available online at www.sciencedirect.com
ScienceDirect
Potentially inappropriate medication use in older people with cancer: Prevalence and correlates Laura K. Saarelainena,b,1 , Justin P. Turnera,c,⁎,1,2 , Sepehr Shakibd , Nimit Singhale,f , Jonathon Hogan-Dorane , Robert Prowseg , Sally Johnsd , Judith Leese , J. Simon Bella,b,c a
Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Parkville, Victoria, Australia School of Pharmacy, Faculty of Health Sciences, University of Eastern Finland, Kuopio, Finland c School of Pharmacy and Medical Sciences, University of South Australia, Adelaide, South Australia, Australia d Department of Clinical Pharmacology, Royal Adelaide Hospital, Adelaide, South Australia, Australia e Department of Medical Oncology, Royal Adelaide Hospital, Adelaide, South Australia, Australia f School of Medicine, Adelaide University, Adelaide, South Australia, Australia g Geriatric and Rehabilitation Medication, Royal Adelaide Hospital, Adelaide, South Australia, Australia b
AR TIC LE I N FO
ABS TR ACT
Article history:
Objectives: Potentially inappropriate medication (PIM) use has been associated with an
Received 9 January 2014
increase in adverse drug events, hospitalization and mortality. This study investigated the
Received in revised form 2 May 2014
prevalence and factors associated with PIM use in patients presenting to a medical oncology
Accepted 24 July 2014
outpatient clinic.
Available online 7 August 2014
Materials and Methods: Consecutive patients (n = 385) aged ≥ 70 years referred to a medical oncology outpatient clinic between January 2009 and July 2010 completed a structured data
Keywords:
collection instrument. The instrument assessed medication use, diagnoses, self-reported
Aged
falls in the previous six months, pain (10-point visual analog scale [VAS]) and distress
Aged 80 and over
(10-point VAS). Frailty was defined using exhaustion, weight loss, Karnofsky Performance
Frail elderly
Scale, instrumental activities of daily living and physical function. PIM use was defined by
Inappropriate prescribing
the Beers Criteria. Logistic regression was used to compute odds ratios (ORs) and 95%
Medical oncology
confidence intervals (CIs) for factors associated with PIM use.
Medication therapy management
Results: In total, 26.5% (n = 102) of the sample used ≥1 PIM. The five most prevalent classes of PIMs were benzodiazepines (n = 34, 8.8%), tricyclic antidepressants (n = 16, 4.2%), alpha-adrenoreceptor antagonists (prazosin) (n = 15, 3.9%), propulsives (metoclopramide) (n = 15, 3.9%) and non-steroidal anti-inflammatory drugs (n = 14, 3.6%). In multivariate analyses, PIM use was associated with age 75–79 years (OR 1.83; 95%CI 1.02–3.26) compared to age 70–74 years, using ≥ 5 medications (OR 4.10; 95%CI 2.26–7.44) compared to
